A laboratory technician packages cerebrospinal fluid of three confirmed meningitis cases to send to the U.S. Centers for Disease Control and Prevention in Atlanta for further testing. / AP / File

Written by

Walter F. Roche Jr.

The Tennessean

A top federal health official says he will not be surprised if new victims of the fungal meningitis outbreak turn up as long as a year after receiving injections with tainted spinal steroids.

Dr. Tom Chiller, medical officer for the Centers for Disease Control and Prevention, issued the warning Wednesday in a conference call with medical professionals across the country who are treating the more than 700 patients infected by the fungus-tainted methylprednisolone acetate shipped from a now-closed and bankrupt Massachusetts drug compounder.

“Our concern is that these infections may remain indolent for long periods of time,” Chiller said, adding that health officials even now are seeing new cases in patients who had treatment as long as six months ago. Many of the new infections, he said, are showing up at the site of the steroid injection.

The conference call came a week after the CDC issued new treatment guidelines calling for vigilance and continued monitoring of those who received shots from three lots of the steroid produced by the New England Compounding Center.

On Monday, federal health officials disclosed new totals of known cases of infections, including the 14 deaths in Tennessee and 722 infections nationwide. In Tennessee, 150 patients have been infected.

Chiller said the new infections may appear in patients who previously had no symptoms of infection.

“Symptoms may be very difficult to distinguish,” he said, noting that all the patients had some underlying medical condition that led to the spinal injections in the first place. “Incubation periods can be very long.”

As the outbreak has played out, Chiller said, he and other health experts have been trying to learn more about how to treat the infections and how long to continue treatment with powerful antifungal agents such as voriconazole, which has serious side effects.

“It is challenging to know when the fungus is gone completely,” he said, adding that those getting treatment “are getting better.”

The callers included a patient who had asked, “How do I know if it will come back?”

Chiller said MRIs would be called for in some cases but he said the agency would not recommend “serial MRIs.” Intervals, he said, should range from several weeks to months.

Chiller was joined by Dr. Anu Malani from a Michigan hospital where dozens of victims have sought treatment.

Malani said more than 100 patients with spinal and paraspinal infections had surgery St. Joseph’s Mercy Medical Center. He said side effects of the favored antifungal ranged from hallucinations to memory loss to hair loss.